Company operating nursing homes in Whittier, Long Beach to pay $48 million in settlement

SOUTHLAND - A company that operates nursing homes in Whittier, Norwalk, Long Beach and three other locations agreed to pay $48 million to resolve allegations it submitted inflated bills to Medicare for services patients didn’t get or weren’t medically necessary, federal officials said.

Ensign Group, Inc., which is based in Mission Viejo, didn’t admit liability with the settlement.

A federal judge in Los Angeles unsealed the case on Monday.

The facilities named in two federal whistleblower lawsuits included the Atlantic Memorial Healthcare Center in Long Beach, Panorama Gardens in Panorama City, Orchard Post Acute Care (also called Royal Court) in Whittier, Sea Cliff Healthcare Center in Huntington Beach, Southland in Norwalk, and Victoria Care Center in Ventura.

“The case against The Ensign Group involves a company that regularly bilked Medicare by submitting inflated bills that, in some cases, sought money for services that simply were never provided to patients,” United States Attorney André Birotte Jr said in a statement.

He said the settlement is one of the largest of its kind in U.S. history.

Between Jan. 1, 1999 and Aug. 31, 2011, the six Ensign facilities allegedly submitted false claims to the government for physical, occupational and speech therapy services provided to Medicare beneficiaries that were not medically necessary, according to Thom Mrozek, spokesman for the U.S Attorney’s Office.

Authorities alleged certain patients were kept in the nursing facilities for periods that exceeded what was medically necessary for the treatment of their conditions.

He said the lawsuit specifically alleged that Ensign improperly incentivized therapists and others to increase the amount of therapy to meet planned targets for Medicare revenue, which were set without regard to patients’ individual therapy needs and could only be achieved by billing at the highest reimbursement levels.

The facilities also allegedly submitted claims for services that were not provided.

Mrozek said the settlement resolves lawsuits filed by two former Ensign employees under the whistleblower provisions of the False Claims Act, which allow private citizens to bring suit on behalf of the government and share in any recovery. How much the whistleblowers will receive hasn’t been determined.